Leberversagen bei Sepsis und Multiorganversagen

  • Kurt Lenz
Chapter

Auszug

Eine Störung der Leberfunktion wird bei etwa 20–25% der Patienten mit Organversagen im Rahmen einer schweren Entzündungsreaktion beobachtet. Obwohl der klinische Parameter hierfür — der Anstieg des Bilirubins — in der Regel erst nach Funktionsstörungen anderer Organe auftritt, zeigen sehr sensitive Nachweismethoden einer hepatalen Dysfunktion, wie die Indozyangrünclearance, dass die Leberbeteiligung ein sehr frühes Ereignis darstellt. Ursache für die Funktionseinschränkung der Leber sind vor allem Zytokine, die Großteils direkt in der Leber selbst auf die verschiedenen Stimuli (Endotoxine, Hypoxie usw.) freigesetzt werden.

Schlüsselwörter

Sepsis Multiorganversagen Leberversagen 
This is a preview of subscription content, log in to check access.

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

Literatur

  1. 1.
    Baker AL, Rosenberg IH (1987) Hepatic complications of total parenteral nutrition. Am J Med 82:489–797PubMedCrossRefGoogle Scholar
  2. 2.
    Bakker J, Grover R, McLuckie A, Holzapfel L, Andersson J, Lodato R, Watson D, Grossman S, Donaldson J, Takala J (2004) Administration of the nitric oxide synthase inhibitor N-Methyl L arginine hydrochloride (546C88) by intravenous infusion for up to 72 h can promote the resolution of shock in patients with severe sepsis: results of a randomized double blind placebo controlled multicener study. Crit Care Med 32:1–12PubMedCrossRefGoogle Scholar
  3. 3.
    DeBakker D, Creteur J, Noordally O, Smail N, Gulbis B, Vincent JL (1998) Does hepatosplanchnic V02/D02 dependency exist in critically ill patients? Am J Resp Crit Care Med 157:1219–1225Google Scholar
  4. 4.
    Bankey PE, Hill S, Gelson D (1994) Sequential insult enhances liver macrophage-signaled hepatocyte dysfunction. J Surg Res 57:185–191PubMedCrossRefGoogle Scholar
  5. 5.
    Bhagat K, Moss R, Collier J, Vallance P (1996) Endothelial “stunning” following a brief exposure to endotoxin: a mechanism to link infection and infarction? Cardiovasc Res 32:822–829PubMedCrossRefGoogle Scholar
  6. 6.
    Bolder U, Ton-Nu HT, Schteingart CD, Frick E, Hofmann AF (1997) Hepatocyte transport of bile acids and organic anions in endotoxemic rats: impaired uptake and secretion. Gastroenterology 112:214–225PubMedCrossRefGoogle Scholar
  7. 7.
    Brealey D, Brand M, Hargreaves I, Heales S, Land J, Smolenski R, Davies NA, Cooper CE, Singer M (2002) Association between mitochondrial dysfunction and severity and outcome of septic shock. Lancet 360:219–223PubMedCrossRefGoogle Scholar
  8. 8.
    Brock RW, Lawlor DK, Harris KA, Potter RF (1999) Initiation of remote hepatic injury in the rat: interactions between kupffer cells, tumor necrosis factor-a, and microvascular perfusion. Hepatology 30:137–142PubMedCrossRefGoogle Scholar
  9. 9.
    Crawford JM, Boyer JL (1998) Clinicopathology conferences: inflammation-induced cholestasis. Hepatology 28:253–260PubMedCrossRefGoogle Scholar
  10. 10.
    Dahn MS, Mitchell RA, Lange PM, Smitz SS, Jacobs LA (1995) Hepatic metabolic response to injury and sepsis. Surgery 117:520–530PubMedCrossRefGoogle Scholar
  11. 11.
    Dahn MS, Lange MP, McCurdy B, Manhaffey S (1995) Metabolic function of the isolated perfused rat liver in chronic sepsis. J Surg Res 59:287–291PubMedCrossRefGoogle Scholar
  12. 12.
    Dahn MS, Wilson RF, Lange MP, Stone A, Jacobs LA (1990) Hepatic parenchymal oxygen tension following injury and sepsis. Arch Surg 125:441–443PubMedGoogle Scholar
  13. 13.
    De Backer D, Creteur J, Preiser J-C, Dubois M-C, Vincent JL (2002) Microvascular blood flow is altered in patients with sepsis. Am J Resp Crit Care Med 166:98–104PubMedCrossRefGoogle Scholar
  14. 14.
    Delvin J, Ellis A, McPeake J, Nigel J, Wendon J, Williams R (1997) N-acetylcysteine improves indocyanine green extraction and oxygen transport during hepatic dysfunction. Crit Care Med 25:236–242CrossRefGoogle Scholar
  15. 15.
    Dirix LY, Poison RJ, Richardson A, Williams R (1989) Primary sepsis presenting as fulminant hepatic failure. Q J Med 73:1037–1043PubMedGoogle Scholar
  16. 16.
    Dünser MW, Hasibeder WR, Wenzel V, Schwarz S, Ulmer H, Knotzer H, Pajk W, Friesenecker BWE, Mayr AJ (2004) Endocrinologic response to vasopressin infusion in advanced vasodilatory shock. Crit Care Med 32:1266–1271PubMedCrossRefGoogle Scholar
  17. 17.
    Ealy DF, Hargreaves T, Lambert HP (1965) Jaundice in severe infection. Brit Med J 2:75–77Google Scholar
  18. 18.
    Editorial Sepsis associated cholestasis (1997) Gastroenterology 112:302–306CrossRefGoogle Scholar
  19. 19.
    Fang MH, Ginsberg AL, Dobbins WO (1980) Marked elevation in serum alkaline phosphatase activity as a manifestation of systemic infection. Gastroenterology 78:592–597PubMedGoogle Scholar
  20. 20.
    Fink MP (2001) Cytopathic hypoxia — Mitochondrial dysfunction as mechanism contributing to organ dysfunction in sepsis. Critical Care Clinics 17:219–233PubMedCrossRefGoogle Scholar
  21. 21.
    Garvin I (1896) Remarks on pneumonia biliosa. South Med J 15:36Google Scholar
  22. 22.
    Gimson AES (1987) Hepatic dysfunction during bacterial sepsis. Intensive Care Med 13:162–166PubMedCrossRefGoogle Scholar
  23. 23.
    Gottlieb ME, Stratton HH, Newell JC, Shah DM (1984) Indocyanine green. Its use as an early indicator of hepatic dysfunction following injury in man. Arch Surg 119:264–268PubMedGoogle Scholar
  24. 24.
    Grotz MR, van Griensven M, Stalp M, Rohde F, Bock D, Krettek C (2001) Glycine reduces the inflammatory response and organ damage in a two hit sepsis model in rats. Shock 16: 116–121PubMedGoogle Scholar
  25. 25.
    Hawker F (1995) SIRS in the critically ill: Is it al liver disease? International Journal Intensive Care Medicine, p 113Google Scholar
  26. 26.
    Hiltebrand LB, Krejci V, Banic A, Erni D, Wheatley AM, Sigurdsson GH (2000) Dynamic study of the distribution of microcirculatory blood flow in multiple splanchnic organs in septic shock. Crit Care Med 28:3233–3241PubMedCrossRefGoogle Scholar
  27. 27.
    Ibanez L, Perez E, Vidal X, Laporte JR (2002) Prospective surveillance of acute serious liver disease unrelated to infectious, obstructive, or metabolic diseases: epidemiological and clinical features, and exposire to drugs. J Hepatol 37:592–600PubMedCrossRefGoogle Scholar
  28. 28.
    Jacob SM, Ruokonen S, Takala J (2002) Effects of dopamine on systemic and regional blood flow and metabolism in septic and cardiac surgery patients. Shock 18:8–13CrossRefGoogle Scholar
  29. 29.
    Joly LM, Monchi M, Cariou A, Chicche JD, Bellenfant F, Brunet F, Dhainaut JF (1999) Effect of dobutamine on gastric mucosal perfusion and hepatic metabolism in patients with septic shock. Am J Resp Crit Care Med 160:1983–1986PubMedGoogle Scholar
  30. 30.
    Kakoullis S, Delude RL, Fink MP (2003) Impaired 02 consumption in HEP3B Hepatocyte like cells incubated with cytomix (TNF IL1β + INF-γ): Pharmacological rescue by agents that scavenge peroxynitrie (0N00-) or inhibit Poly(ADP-Ribose) Polymerase (PARP) Crit Care Med 30:A52Google Scholar
  31. 31.
    Kakoullis S, Tawadrous ZS, Delude RL, Fink MP (2003) Ethylpyruvate ameliorates impaired hepatic 02 consumption in endotoxemic mice. Crit Care Med 30:A10Google Scholar
  32. 32.
    Kantrow SP, Taylor DE, Carraway MS, Piantadosi CA (1997) Oxidative metabolism in rat hepatocytes and mitochondria during sepsis. Arch Biochem Biophys 345:278–288PubMedCrossRefGoogle Scholar
  33. 33.
    Kimura S, Yoshioka T, Shibuya M, Sakano T, Tanaka R, Matsuyama S (2001) Indocyanine green elimination rate detects hepatocellular dysfunction early in septic shock and correlates with survival. Rit Care Med 29:1159–1163CrossRefGoogle Scholar
  34. 34.
    Lenz K, Kleinberger G, Druml W, Laggner A (1982) Die Schockleber. Leber Magen Darm 12:198–202PubMedGoogle Scholar
  35. 35.
    Malay MB, Ashton JL, Dahl K, Savage EB, Burchell SA, Ashton RC, Sciacca RR, Oliver JA, Landry DW (2004) Heterogenitiy of the vasoconstrictor effect of vasopressin in septic shock. Crit Care Med 32:1327–1331PubMedCrossRefGoogle Scholar
  36. 36.
    Meier-Hellmann A, Bredle DL, Specht M, Spies C, Hannemann L, Reinhart K (1997) The effects of low-dose dopamine on splanchnic blood flow and oxygen uptake in patients with septic shock. Intensive Care Med 23:31–37PubMedCrossRefGoogle Scholar
  37. 37.
    Meier-Hellmann A, Reinhart K, Bredle DL, Specht M, Spies C, Hannemann L (1997) Epinephrine impairs splanchnic perfusion in septic shock. Crit Care Med 25:399–404PubMedCrossRefGoogle Scholar
  38. 38.
    Neviere R, Mathieu D, Chagnon JL, Lebleu N, Millien JP, Wattel F (1996) Skeletal muscle microvascular blood flow and oxygen transport in patients with severe sepsis. Am J Resp Crit Care Med 153:191–195PubMedGoogle Scholar
  39. 39.
    Pirovino M, Meister F, Rubli E, Karlaganis G (1989) Preserved cytosolic and synthetic liver function in jaundice of severe extrahepatic infection. Gastroenterology 96:1589–1595PubMedGoogle Scholar
  40. 40.
    Poeze M, Ramsay G, Buurman WA, Greve JWM, Dentener M, Takal J (2002) Increased hepatosplanchnic inflammation precedes the development of organ dysfunction after elective high risk surgery. Schock 17: 451–458CrossRefGoogle Scholar
  41. 41.
    Rank N, Michel C, Haertel C, Lenhart A, Weite M, Meier-Hellmann A, Spies C (2000) N-acetylcysteine increases liver blood flow and improves liver function in septic shock patients: results of a prospective, randomized, double blind study. Crit Care Med 28:3799–3807PubMedCrossRefGoogle Scholar
  42. 42.
    Rivers E, Nguyen B, Havstad S, Ressler J, Muzzin A, Knoblich B, Peterson E, Tomlanovich M (2001) Early goal directed therapy in the treatment of severe sepsis and septic shock. N Engl J Med 345:1368–1377PubMedCrossRefGoogle Scholar
  43. 43.
    Rosser DM, Manji M, Cooksley H, Bellingan G (1998) Endotoxin reduces maximal oxygen consumption in hepatocytes independent of any hypoxic insult. Intensive Care Med 24:725–729PubMedCrossRefGoogle Scholar
  44. 44.
    Roukonen E, Takala J, Kari A, Saxen H, Mertsola J, Hansen EJ (1993) Regional blood flow and oxygen transport in septic shock. Crit Care Med 21:1296–1303CrossRefGoogle Scholar
  45. 45.
    Sakka SG, Reinhart K, Meier-Hellmann A (2000) Prognostic value of the Indocyanine green plasma disappearance rate in critically ill patients. Chest 122:1715–1720CrossRefGoogle Scholar
  46. 46.
    Sakka SG, Reinhart K, Meier-Hellmann A (2001) Does the optimization of cardiac output by fluid loading increase splanchnic blood flow? Brit J Anaesthesia 86:657–662CrossRefGoogle Scholar
  47. 47.
    Schwartz DB, Bone RC, Balk RA, Szidon JP (1989) Hepatic dysfunction in the adult respiratory distress syndrome. Chest 95:871–875PubMedCrossRefGoogle Scholar
  48. 48.
    Shee-Chen SM, Chen HS, Ho HT, Chen WJ, Sheen CC, Eng HL (2002) Effect of bile acid replacement on endotoxin induced tumor necrosis factor a production in obstructive jaundice. World J Surg 26:448–450CrossRefGoogle Scholar
  49. 49.
    Sheron N, Goka J, Wendon J, Keays R, Keane H, Alexander G, Williams R (1990) Highly elevated plasma cytokines in fulminant hepatic failure: correlations with multiorgan failure and death (abstr) Hepatology 12: 939AGoogle Scholar
  50. 50.
    Tadros T, Trabe DL, Herndon DN (2000) Hepatic blood flow and oxygen consumption after burn and sepsis. J Trauma 49:101–108PubMedCrossRefGoogle Scholar
  51. 51.
    Trauner M, Fickert P, Stauber RE (1999) Inflammation induced cholestasis. J Gastroenterol Hepatol 14:946–959PubMedCrossRefGoogle Scholar
  52. 52.
    Utili R, Abernathey CO, Zimmerman HJ (1976) Cholestatic effects of escheria coli endotoxin on the isolated perfused rat liver. Gastroenterology 70:248–253PubMedGoogle Scholar
  53. 53.
    Vara E, Aria-Diaz J, Torres-Melero J, Garcia C, Rodriguez JM, Balibrea JL (1994) Effect of different sepsis-related cytokines on lipid synthesis by isolated hepatocytes. Hepatology 20: 924–931PubMedCrossRefGoogle Scholar
  54. 54.
    Vermillon S, Gregg J, Baggenstossa A (1969) Jaundice associated with bacteriaemia. Arch Intern Med 124:611–616CrossRefGoogle Scholar
  55. 55.
    Vincent JL, DeBacker D (2001) Inotrope/Vasopressor support in sepsis induced organ hypoperfusion. Sem Resp Crit Care Med 22:61–73CrossRefGoogle Scholar
  56. 56.
    Wang P, Zheng FB, Chaudry IH (1991) Hepatic extraction of indocyanine green is depressed early in sepsis despite increased hepatic blood flow and cardiac output. Arch Surg 126:219–224PubMedGoogle Scholar
  57. 57.
    Wang P, Chaudry IH (1996) Mechanism of hepatocellular dysfunction during hyperdynamic sepsis. Am J Physiol 270:R927–R938PubMedGoogle Scholar
  58. 58.
    Wang P, Ba ZF, Chaudry IH (1991) Hepatic extraction of indocyanine green is depressed early in sepsis despite increased hepatic blood flow and cardiac output. Arch Surg 126: 219–224PubMedGoogle Scholar
  59. 59.
    Yang S, Koo DJ, Zhou M, Chausry I, Wang P (2000) Gut derived norepinephrine plays a critical role in producing hepatocellular dysfunction during early sepsis. Am J Physiol Gastrointest Liver Physiol 279:G1274–G1281PubMedGoogle Scholar
  60. 60.
    Yang S, Koo SJ, Chaudry IH, Wang P (2001) Glycine attenuates hepatocellular depression during early sepsis and reduces sepsis-induced mortality. Crit Care Med 29:1201–1206PubMedCrossRefGoogle Scholar
  61. 61.
    Zhang H, Smail N, Cabrai A, Rogiers P, Vincent JL (1997) Effects of norepinephrine on regional blood flow and oxygen extraction capabilities during endotoxic shock. Am J Resp Crit Care Med 155:1965–1971PubMedGoogle Scholar
  62. 62.
    Zimmermann H, Thomas L (1950) The liver in pneumococcal pneumonia. Observation in 94 cases on liver function and jaundice in pneumonia. J Lab Clin Med 35:556–562Google Scholar

Copyright information

© Steinkopff Verlag 2006

Authors and Affiliations

  • Kurt Lenz
    • 1
  1. 1.Medizinische Abteilung mit IntensivstationKonventspital der Barmherzigen BrüderLinzAustria

Personalised recommendations